As World Suicide Prevention Day (10 September) draws attention to suicide prevention across the globe, we spoke with Professor Alexandra Pitman, psychiatrist at UCL and Honorary Consultant at North London NHS Foundation Trust about her research, her upcoming study on patient observation in psychiatric wards, and why collaboration and compassion are vital.
Q. How has the landscape of suicide and self-harm research changed since you began in 2007?
A. The research community has grown enormously and so has collaboration. It’s heartening to see how much altruism there is in people working together on such an important public health problem. Around 22% of the population will know someone who has died by suicide, so this is something that touches almost all of us.
We now understand more about why people self-harm. Sometimes it’s linked to suicidal intent, but often it isn’t, it can be a way of coping with distress. In that sense, it may actually protect people from suicide, although of course it carries its own risks. Thanks to qualitative research, we’ve become better at listening to these different motivations.
New methods like Ecological Momentary Assessment allow us to track suicidal thoughts at different times of day. They confirm what patients have long told us: suicidal thoughts can change rapidly and are highly dynamic.
Q. Your next study looks at Enhanced Patient Observation (EPO). Why focus on this?
A. Psychiatric wards are designed to reduce risk yet every year, the National Confidential Inquiry into Suicide and Safety in Mental Health reports a concerning number of suicides among inpatients. Some even occur while patients are under one-to-one observation.
The idea of the study emerged when I was working as a ward consultant, I saw the pressure this puts on patients, staff, and families. Close observation sometimes called “specialling” is widely used, but often described negatively. Patients can feel uncomfortable sitting with someone they don’t know, and staff can struggle if they’re not trained in how to engage therapeutically.
Given how much time and resource mental health services invest in this practice, it’s remarkable how little evidence we have about whether it works. Our study will ask: is EPO effective, is it cost effective, and how do patients, carers, and staff actually experience it?
Q. You’ve involved people with lived experience from the beginning. How has that shaped the project?
A. Hugely. Some patients told us observation was the best thing about their admission, giving them space to talk. Others said it made them feel more unsafe and more at risk. Nurses also voiced uncertainty about the purpose of EPO, sometimes seeing it as an attempt to be seen to be protecting a patient, but not in a way that they found to be very therapeutic.
That range of views convinced us to approach the research with an open mind. We’ve involved people with lived experience as co-applicants and co-investigators, with funding to ensure their contributions are properly supported. Having their perspective at the table means our study is more relevant and respectful of those it’s intended to support.
Q. Beyond this, what areas of suicide prevention need more attention?
A. I’m very interested in the cognitive availability of suicide, essentially, how present and accessible the idea of suicide is in someone’s mind. Media reporting, cultural narratives, and personal experiences all make suicide more cognitively available, sometimes from a young age.
For someone already feeling trapped, exposure to these influences can make suicide feel like an available option. Understanding, and buffering, these influences should be a priority for future research.
Q. What keeps you motivated in such a difficult field?
A. The sheer need. So many patients describe feeling stuck, convinced that nothing will help and that others would be better off without them. This makes it really hard for them to see a way out of their problems, and why suicide seems like a release.
We still have a long way to go in finding interventions that meet the diverse needs of people with suicidal thoughts. There is no one-size-fits-all solution, we need tailored approaches that people find acceptable, since even evidence-based treatments may not work for everyone.
What also sustains me is the chance to collaborate – not only with people with lived experience but also with colleagues in spatial geography, media communications, psychology, medical sociology, anthropology, computer science, and more. Suicide is complex, so the more perspectives we bring, the better our chance of making a difference.
Q. What message would you like to leave people with this World Suicide Prevention Day?
A. Do one simple thing: open your browser, type “support for suicidal thoughts”, and familiarise yourself with what comes up. You may never need it, but if a friend, colleague, or family member tells you they’re struggling, you’ll know where to point them.
Being prepared helps us all contribute to this year’s theme, “Changing the Narrative on Suicide”. It’s about having open, compassionate conversations, challenging harmful myths, and reducing stigma. Just knowing where support is available can show someone you understand, and that can make a real difference.
The Enhanced Patient Observation Study is sponsored by North London NHS Foundation Trust and funded by the NIHR. For more information, contact: DoP.EPO@ucl.ac.uk.
For more information on World Suicide Prevention Day, please visit About World Suicide Prevention Day from the International Association for Suicide Prevention.
The Samaritans have a range of resources available on helping to prevent suicide, please visit their pages for more information: World Suicide Prevention Day | Samaritans. Call 116 123 for free to talk to a Samaritan.